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Advances in the intraoperative delineation of malignant glioma margin
Shan Jiang1, Huihui Chai1, Qisheng Tang1
1Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
Abstract:
Surgery plays a critical role in the treatment of malignant glioma. However, due to the infiltrative growth and brain shift, it is difficult for neurosurgeons to distinguish malignant glioma margins with the naked eye and with preoperative examinations. Therefore, several technologies were developed to determine precise tumor margins intraoperatively. Here, we introduced four intraoperative technologies to delineate malignant glioma margin, namely, magnetic resonance imaging, fluorescence-guided surgery, Raman histology, and mass spectrometry. By tracing their detecting principles and developments, we reviewed their advantages and disadvantages respectively and imagined future trends.
Insights
Accurately identifying malignant glioma margins during surgery is challenging. This study reviews four intraoperative technologies—magnetic resonance imaging, fluorescence-guided surgery, Raman histology, and mass spectrometry—to improve tumor margin delineation for better patient outcomes.
Area of Science:
- Neurosurgery
- Oncology
- Medical Technology
Background:
- Malignant glioma surgery is critical but hampered by infiltrative growth and brain shift.
- Distinguishing tumor margins visually or preoperatively is difficult for neurosurgeons.
- Precise intraoperative margin delineation is essential for effective glioma treatment.
Purpose of the Study:
- To review and compare four intraoperative technologies for delineating malignant glioma margins.
- To analyze the principles, development, advantages, and disadvantages of each technology.
- To project future trends in intraoperative glioma margin detection.
Main Methods:
- Review of magnetic resonance imaging (MRI) for intraoperative guidance.
- Analysis of fluorescence-guided surgery (FGS) techniques.
- Evaluation of Raman histology for real-time tissue analysis.
- Assessment of mass spectrometry (MS) for molecular profiling at the tumor margin.
Main Results:
- Each technology offers unique capabilities for margin detection.
- MRI provides anatomical context, while FGS enhances visualization.
- Raman histology and MS offer molecular-level insights into tumor boundaries.
- Comparative analysis highlights the strengths and limitations of each approach.
Conclusions:
- Advanced intraoperative technologies significantly improve the ability to delineate malignant glioma margins.
- Combining different technologies may offer synergistic benefits for precision surgery.
- Continued technological development is crucial for advancing glioma treatment and patient survival.
